1598874042 NPI number — ALEXANDRE HAGEBOUTROS MD

Table of content: ALEXANDRE HAGEBOUTROS MD (NPI 1598874042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598874042 NPI number — ALEXANDRE HAGEBOUTROS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGEBOUTROS
Provider First Name:
ALEXANDRE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598874042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 HADDON AVE
Provider Second Line Business Mailing Address:
E&R BUILDING 270
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08103-1505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-963-3572
Provider Business Mailing Address Fax Number:
856-338-9211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 CENTENNIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-4689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-325-6750
Provider Business Practice Location Address Fax Number:
856-325-6777
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MA60394 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0475739 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6234704 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P441764 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14822 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1260900 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110115409 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3521183 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3K5923 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500004 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1051788 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".




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